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Preview

Summary

The personal interface between clinician and patient is a misunderstood subject which can impact all areas of health care. Without adequate training in relationship science clinicians inadvertently contribute to empathic failure, poor medical decision process, difficulty changing health-related behavior, costly variation and derailment of care, extra litigation, and clinician burnout.

Relationship Power in Health Care presents new knowledge and skills that empower health care and wellness professionals to become competent facilitators of behavior and lifestyle change, information transfer, and medical decision making in collaboration with their patients.

The new approaches are supported by a wide variety of research and clinical evidence, derived from modern psychotherapy, brain biology, and the latest advances in health coaching and nursing science. Putting them to work to improve health care makes good sense both scientifically and ethically.

This comprehensive text integrates past health psychology models starting from the 1950s with recent advances made since the 1990s in relationship psychology and interpersonal neurobiology. It also includes videos of brief medical interviews along with analysis of the strategies and tactics used.

The tactics outlined and the interview demonstrations, conducted by a highly experienced clinical social worker and nurse Joanne Gaffney, offer a unique opportunity for all clinicians to acquire valuable skills in both clinician self-care and patient care.

Table of Contents

OVERVIEW

Introductory Discussion and Overview Why This ProjectLooking for Pathways to Improve: Interpersonal RelationshipsTheory, Strategy, TacticsMaintaining Relationships While Also Diagnosing and TreatingFitting into the Larger Context of Health Care

Past Health Psychology and Neuroscience (Prior to the Early 1990s) Health-Related Models in Use List Going Deeper into EachPresent Advances in Relationship Psychology (After Early 1990s):A Relational Context for Diagnosis and Treatment List of Seven Advances in Relationship PsychologyGoing Deeper into Each Advance Advances in Nursing Conclusions about Advances in Relationship Psychology

Present Advances in Neuroscience (Starting with the Early 1990s):Possible Neural Substrates of Mind Functions Nine Advances in NeuroscienceGoing Deeper into Each Advance Discussion Basics of Updated Functional NeuroscienceEnabling Advances in Technology Closing CommentsBUILDING NEW THEORETICAL HYPOTHESES, STRATEGIES, AND TACTICS FOR CLINICIANS

Integration of Past with Present Advances (Selections of Elements to Include in a New Model) Introduction Selection of Elements for Inclusion in a New Model Formulations of Theoretical Hypotheses and Strategies of Relational Patient CareFormulation of Updated Theoretical Hypotheses Formulation of Updated Strategies A Summary of Updated Strategies in Shared Medical Decision MakingDiscussion Tactical Competencies and FrameworksIntroduction Two Frameworks to Visualize Core Tactics in Interviewing: Common Tactical Components that Implement All the Strategies

Pathways in Education and Training Medical School and Residency Training Nursing Education Take-Aways from the Earlier Nurse Training Programs A Generic Framework for Curriculum Design Health Coaching: What Is It? Who Does It? Where Is It Going?

Reviews

"When people are sick they are also highly vulnerable and impressionable. Interactions with health care professionals take on tremendous import and can strongly affect: the course of their illnesses; how well they follow clinical advice; and how they feel about and care for themselves. Livingstone and Gaffney not only elucidate this widespread problem, providing compelling research, but offer a clear and practical training to ameliorate it. This training is not only conveyed in Livingstone's highly readable prose but also well illustrated by Gaffney's video examples. Changing the way health care professionals relate to patients is a hugely ambitious task. This book is a leap forward in that endeavor." – Richard C. Schwartz, PhD, developer of the Internal Family Systems model of psychotherapy

"This long-awaited book provides an evidence-based and highly practical approach to health communication. Clinical instructors and trainees who utilize this unique resource will have the tools at hand to develop increasingly satisfying and effective therapeutic interactions over time." – Jennifer E. Potter, MD,Associate Professor, Harvard Medical School and Beth Israel Deaconess Medical Center and Children’s Hospital

"This book is an exploration into teaching and learning; interpersonal psychology and neurobiology, medical decision making and clinician self-care. It is for the faculty as teacher and the faculty as learner. It dares to bring the expert healer into the power of being healed in order to heal others. It challenges those who know the science of learning to know themselves. Turning these pages provides the opportunity to become an inter-professional educator building a bridge between nurses and doctors for the well-being of patients while providing a wealth of indispensable knowledge. This is where health care must go…." – Beverly Malone, PhD, RN, FAAN, CEO, National League for Nursing; Former President of the American Nurses Association; and Former General Secretary of the Royal College of Nursing (UK)

"What the authors show us is their process of combining the best elements of the past and the present advances in science for the formation of a new model. But the book is far from a theoretical textbook. It offers very practical approaches, tools, and methodologies that can be immediately implemented by any health professional…I truly hope that the health care profession will pay attention to this brilliant work and many recommendations for a new paradigm in relational power. As a patient, I want my physician to read this book." – Magdalena N. Mook, Executive Director/CEO, International Coach Federation, USA

"This is a valuable resource for all clinicians who want to develop a better way to communicate with their patients, so that both clinician and patient feel that there is an important exchange of information that supports a common goal of improved health outcomes. It is also an exceptionally useful tool for faculty who want to instill a behavioral change that students will use as a lifelong strategy for effective therapeutic interactions." – Cheryl Leiningen, DNP, RN, APN-C(Monmouth University School of Nursing and Health Studies), Doody Enterprises

"Congratulations to the authors and my respect for what they have achieved. Their voice is needed. It brings attention to effective communication toward giving and receiving trust and care. I believe the practice of their integrated model is valuable for all our communications, professionally being a salient example of an application of Interpersonal Science." – Silvio J. Onesti, Jr, MD, Associate Professor and former Chief of Child and Adolescent Psychiatry, Harvard Medical School at McLean Hospital.

"The book is organized more as a teaching tool than as a read-it-in-one-sitting narrative. It is designed to be used as a workbook of specific lessons to guide the reader-clinician in learning to be more attuned to what’s going on beneath the surface in medical encounters. It is a must for faculty…The authors include links to a number of videos that analyze, almost sentence by sentence, interviews between a clinician and patient. The videos, and accompanying annotations in the book’s text, show when the patient begin to struggle with emotional reactions to his or her medical problem and, just as important, when the clinician does – and doesn’t – 'get' what’s going on with his or her own feelings. In the detailed annotations, the authors dissect these interactions, showing how, with training, an emotionally-attuned clinician can help patients process medical information in deeper, more honest ways that ultimately facilitate behavior change and clarify important medical choices." – Judy Foreman, health columnist and author of A Nation in Pain

"Wonderful!!! I think it’s absolutely outstanding! It’s going to be required reading for my graduate students at CIIS…They’ve done this incredible job of organizing all these historical models and theories into a conceptual framework that finally makes sense for me…I not only want to thank the authors for the countless hours of research and writing and testing and analyzing that went into this book, but I’m grateful for the spirit of generosity in which they bring their readers along, step by step, sharing how they arrived at the SINHC model." – Professor Meg Jordan, California Institute of Integral Studies

"This comprehensive, practical and theory-based guide to enhancing patient care and outcomes through effective communication is a must read for any practitioner training in the important field of health coaching today." – Dr Nancy Shadick, Brigham and Women's Hospital

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